1. Working with multidisciplinary teams Josanne K. Pagel MPAS, PA-C, Karuna RMT®

2. Objectives  Identify the different healthcare individuals involved with patient care  Discuss how a PA interacts with each healthcare worker  Discuss challenges, opportunities, with working with multidisciplinary teams

3. The Ripple effect  Everything we say, touch and do, has an effect on everyone around us.  Drop a pebble in the water, and the ripples will spread out for what seems like an eternity. Yet, the ripples may have other effects. It may frighten a duck, causing it to fly away, or bounce off a rock, scaring a school of fish. The simple act of casting a pebble into the pond causes changes to all around.  What you do today, may affect many tomorrow.

4. Who’s part of the health care team?  Physicians  Nurses  Fellows  Residents  PAs  Unit assistants  PT  OT  Case Managers  Pastoral care  Lab  EVS  Dietary  Who else?

5. What role do they all play?  Physician: Team leader  Nurses:  PAs:  Fellows and Residents:  Unit Assistants:  PT & OT:  Case Managers:  Pastoral care:  Lab:  EVS:  Dietary:  Who else?

6. Initiatives  HCAHPS: ; (pt satisfaction; medication communication, infections, etc)  HCAHPS: Hospital Consumer Assessment of Healthcare Providers and Systems) ; (pt satisfaction; medication communication, infections, etc)  Joint Commission; standards of care; pt involvement, education  CMS; one complaint will bring them to you  Press Ganey; patient satisfaction with care  Gallop; employee engagement  Other regulating/monitoring bodies  All initiatives are geared towards outcomes

7. LOS initiative  You are tasked with decreasing the length of stay of your patients  You are tasked with making sure all discharges are written by 10am on DOD  You are tasked with decreasing opportunity days  You are tasked with making sure your patients are not re-admitted to the hospital

10. Case Example:  Arrives to office @ 6:45am  Reviews inpatient records, nursing notes, night fellow notes, emails  Rounds autonomously on all her patients  Meets with Fellow, short discussions  Staff arrives on floor  Fellow, PA and Staff round  10:45am to 11:45am: Residents huddle; staff, fellow and PA  Quick lunch  Meet with fellow; discuss patient management  Afternoon is completing discharges, patient orders, management  Sign out to night Fellow  4:30: office: finish emails, documents  5pm: Residents presentations (DDI)  What’s missing, if anything???

11. Better communication:  Arrives to office @ 6:45am  Reviews inpatient records, nursing notes, night fellow notes, emails  Gets hand off from night Fellow  Rounds autonomously on all her patients  Meets with day Fellow, short discussions  Meets with NM, ANM for report on nursing support, update on pts.  Meets with case management for Discharge planning  Staff arrives on floor  Fellow, PA and Staff round  10:45am to 11:45am: Residents huddle; staff, fellow and PA  Quick lunch  Meet with fellow; discuss patient management  Huddle with nursing for update on any changes.  Huddle with case management  Afternoon is completing discharges, patient orders, management  Sign out to night Fellow  4:30: office: finish emails, documents  5pm: Residents presentations (DDI)

13. Office setting is no different  Who’s involved?: Physician Physician Nurses Nurses Office manager Office manager PAs PAs Coders and billers Coders and billers Outside office personnel Outside office personnel Hospital personnel (for referrals) Hospital personnel (for referrals)

14. Summary  What is the value of the multidisciplinary team?  Who’s in-charge of the team?  What personal characteristics should you possess to assure success with working with multidisciplinary teams?

15.  Questions?